Sport Insurance Solutions. Australian Veterans Cycling Council Inc National Insurance Program Handbook

Transcription

1 Sport Insurance Solutions Australian Veterans Cycling Council Inc National Insurance Program Handbook

2 Australian Veteran Cycling Council Inc. Arthur J. Gallagher Co (Aus) Limited ABN PO Box 1113 BRISBANE QLD 4001 E: T: 1800 SPORT 0 ( ) F: (07) Attention: Australian Veteran Cycling Council Inc. Members, Players and Officials Arthur J. Gallagher has been working in close partnership with the Australian sports industry for over thirty years, developing insurance and risk protection programs that identify and address the risks associated with sport. We are extremely delighted to work in partnership with both AVCC and all affiliated bodies to provide a program designed to improve all aspects of a member s physical, legal and financial safety. We have pleasure in enclosing details of the 2017 Insurance Program for Australian Veteran Cycling Council Inc., which is extended to all affiliated associations, clubs and their members. The insurance program provides the following cover: Public and Products Liability with Professional Indemnity Insurance Sports Injury Rehabilitation (Personal Accident) Insurance The benefits provided by the program are not comprehensive and we would encourage all participants to take out Private Health, Life and Income Protection Insurance according to their own individual circumstances. To maximise our service to all Affiliated Associations, Clubs and Members, we have a specialised sports team with a dedicated Team Leader, an Account Executive, an Assistant Account Executive, a Claims Manager and two in-house Sports Claims Specialists. If you have any queries in regard to this insurance program or require assistance with any other insurance or risk management matters please give us a call. We look forward to providing exceptional service to the Fencing community. Yours sincerely, Robert Dickinson Sports Account Executive Arthur J. Gallagher 2

3 Contents Section 1 Insurance Program... 2 Sports Public & Products Liability Including Professional Indemnity Insurance... 2 Sports Injury Group Personal Accident Insurance... 3 Section 2 Claims Procedures... 6 General information... 6 Public liability claims incident reporting procedure... 6 Sports injury (personal accident) claims Season Insurance Renewal Report Section 3 Frequently asked questions... 8 Section 4 Other matters... 9 Certificates of insurance... 9 Hold harmless agreements... 9 Insuring the interest of other parties... 9 Utmost good faith... 9 Notice regarding this manual... 9 Section 3 Appendices... 10

4 Australian Veteran Cycling Council Inc. Section 1 Insurance Program Sports Public & Products Liability Including Professional Indemnity Insurance Period of insurance 31 st December 2016 at 4pm Local Standard Time to 31 st December 2017 at 4pm Local Standard Time Who is covered? Insurer/Security Insured Activities Geographical Limits Deductible Scope of Cover Australian Veterans Cycling Council Inc (AVCC); All AVCC registered clubs and their members, volunteers, officials, umpires and adjudicators Offshore Market Placements (Australia) through Lloyds of London For registered members of the AVCC, benefits are applicable to third party injury occurring during any and all bike riding activities 24hrs a day, unless the AVCC insured member is competing in an event / race that is not conducted under the endorsed protocols of the AVCC Inc. Worldwide Excluding USA & Canada $1,000 each and every occurrence Your legal liability to third parties, happening during the Period of Insurance, as a result of an occurrence that is connected with your Insured Activities. Limit of Indemnity $20,000,000 Public / Advertising Liability Any One Occurrence $20,000,000 Products Liability Any One Period of Insurance $20,000,000 Advertising Liability Any One Occurrence $ 5,000,000 Professional Indemnity Any One Occurrence and in the aggregate Endorsements Participation cover Exclusions $ 100,000 Property in Physical or Legal Control of the Insured Any One Occurrence and in the aggregate The insured is covered in respect of a claim for personal injury or property damage brought by or in respect of a participant competing and/or practising in a covered activity. Significant Risks Exclusions, pg 6. Your insurer will not pay for: A heart condition, stroke or other cardiovascular condition if the member is over 35 years of age. Is removed and replaced with: Your insurer will not pay for: A heart condition, stroke or other cardiovascular condition 2

5 Australian Veteran Cycling Council Inc. Sports Injury Group Personal Accident Insurance Period of insurance 31 st December 2016 at 4pm Local Standard Time to 31 st December 2017 at 4pm Local Standard Time Insured Persons Australian Veterans Cycling Council Inc (AVCC); All AVCC registered clubs and their members, volunteers, officials, umpires and adjudicators. Personal Accident - Members For registered members of the AVCC, benefits are applicable to injury occurring during any and all bike riding activities 24hrs a day, unless the AVCC insured member is competing in an event / race that is not conducted under the endorsed protocols of the AVCC Inc. Cover also includes staying away from home and travel to take part in a competition, game, performance, social function, training session or administrative activities. Personal Accident - Volunteers Engaged in administrative, fundraising or volunteer activities. The competitions, games, performances, social functions, training sessions, administrative, fundraising or volunteer activities must be: Age Limitations Insurer/Security Geographical Limits The policy is endorsed to automatically include any insured person over the age of 4 and under the age of 100 years. In the case where the insured person is aged 80 years of age and older, we will require Medical Clearance certificate to be provided and held by Arthur J. Gallagher every 12 months. Offshore Market Placements (Australia) through Lloyds of London (Mitsui Sumitomo Underwriting). Australian Based Claims handling, with direct Arthur J. Gallagher Sports Injury Claims Settlement Authority. Worldwide Sums insured Capital Benefits The cover under this section provides $100,000 for death resulting from accident except for training/social riding which is limited to $10,000. All other permanent disabilities are calculated using a percentage of the death benefit depending on the severity of the injury. For full details of these percentages, please refer to the Schedule of Capital Benefits contained in the policy wording. Funeral Expenses The cover under this section reimburses funeral costs up to a maximum of $5,000. In Memoriam Benefit The cover under this section provides for reasonable costs associated with observance of the death of a Member up to a maximum amount of $1,000. 3

6 Australian Veteran Cycling Council Inc. Modification Expenses The cover under this section provides for costs necessary up to a maximum of $10,000 to modify the Member s home and/or motor vehicle, or relocating to a suitable home if they are entitled to 100% of the Capital Benefit. Medical and Dental Costs The cover under this section reimburses 80% of non-medicare medical treatment including ambulance, hospital accommodation / theatre fees, orthotics, splints, prosthesis, treatments given by a dentist, chiropractor, masseur, naturopath, osteopath or physiotherapist. The maximum benefit for this section is $1,500. All treatment must be certified by a registered medical practitioner and not subject to any Medicare rebate. All claims are subject to a $50 excess if no private health cover. Any expenses must be incurred within 12 months of the insured person sustaining the injury. Loss of Earnings The cover under this section pays 100% of the Members actual weekly income, up to a maximum of $500 per week, subject to a 14 day deferral period. Please note that income earned from participating in the sport is not covered. The benefit will be paid for the period of the Disablement as certified by a registered medical practitioner or 52 weeks whichever is the lesser. Student Help The cover under this section reimburses 100% of the cost of Home Tutorial by a qualified tutor, up to a maximum of $500 per week and subject to a 14 day deferral period. The benefit will be paid for the period of the Disablement as certified by a registered medical practitioner or 52 weeks whichever is the lesser. Home Help The cover under this section reimburses 100% of the actual costs incurred for Home Help from a recognised and licensed Domestic Help Agency, up to a maximum of $500 per week and subject to a 14 day deferral period. The benefit will be paid for the period of the Disablement as certified by a registered medical practitioner or 52 weeks whichever is the lesser. Parents Allowance The cover under this section reimburses $25 per day in-patient benefit to a full time student under 25 years of age for continuous confinement in hospital because of an accident. The benefit is limited to $1,500. Dependent Children s Allowance The cover under this section provides for reasonable costs incurred by the Dependent Children of a Member whilst the Member is undergoing medical treatment. The benefit is limited to $500. Home Nursing Care The cover under this section provides for nursing care provided by a registered nurse (not related to the Member) where they are confined to bed for a period of not less than 7 days if certified medically necessary. The maximum weekly benefit payable is $300 per week, and is subject to a 7 day deferral period. The benefit will be paid for the period of the Disablement as certified by a registered medical practitioner or 52 weeks whichever is the lesser. Ancillary Non-Medical Expenses The cover under this section provides for ancillary non-medical expenses (expenses related to medical treatment if certified as necessary. i.e. expenses includes such items as travel to receive treatment, but does not include wages lost by any person). The maximum payable under this benefit is $1,500. 4

7 Australian Veteran Cycling Council Inc. Rehabilitation Benefits The cover under this section provides for reimbursement of: (a) Tuition or advice fees from a vocational college if certified as necessary and agreed to. The maximum payable under this benefit is $3,000. (b) Rehabilitation expenses (eg gym membership) certified as necessary and agreed to. The maximum payable under this benefit is $500. Unexpired Membership Reimbursement Benefit The cover under this section provides for pro-rata refund of your club s or association s membership/registration fee from the date of injury if the Member can t play for the rest of the season. The maximum payable under this benefit is $500. Double Capital Sum Insured The cover under this section provides for double the Capital Sum Insured to be paid for a person under 12 years of age who suffers: permanent total disablement or permanent paralysis of all limbs. Miscarriage and Premature Childbirth The cover under this section provides for $2,500 compensation for Miscarriage and Premature Childbirth as a direct result of an Accident whilst participating. HIV The cover under this section provides for 10% of the Permanent Total Disability Benefit 1. as listed in the Schedule of Capital Benefits if contracted as a result of an Accident. Kidnapping The cover under this section provides for 10% of the Permanent Disability Benefit 1 as listed in the Schedule of Capital Benefit. Exclusions Sports Injury Section 1, What s Not Covered (in addition to General Exclusions) pg 27. Point 2: Death disability or injury that is due to: b) A heart condition, stroke or other cardiovascular condition the member is over 35 years of age. This exclusion is removed and replaced with: b) A heart condition, stroke or other cardiovascular condition. Please note: The cover outlined is a broad summary only - please refer to the policy wording for details of the terms and conditions, including exclusions. 5

8 Australian Veteran Cycling Council Inc.. Section 2 Claims Procedures General information The following basic rules will assist in the smooth and speedy settlement of all claims: Notify claim to the appropriate person/party as soon as possible. At no stage should liability be admitted. All summons/writs concerning insurance must be sent to Arthur J. Gallagher & Co (Aus) Limited. When a criminal act is involved or suspected, the police must be notified. Receive insurer s authorisation prior to repairing/replacing damaged property or equipment, except in instances where there is potential for further loss or damage, whereupon immediate action should be taken. More detailed instructions relative to specific types of claims are provided on the following pages for: Public Liability and Professional Indemnity Association Liability (Directors & Officers) Sports Injury (Personal Accident) Public liability claims incident reporting procedure 1. Incident Reporting In the event of any incident which may give rise to a claim, the affiliated club/owner/operator is required to immediately inform the state and/or national official of the AVCC and Robert Dickinson of Arthur J. Gallagher on (07) or robert.dickinson@ajg.com.au. The most important points to be borne in mind upon the happening of an incident likely to involve a claim are: full details of the circumstances should be obtained on the spot by completing an Accident &/or Incident Report form; the names and addresses of all witnesses (preferably independent) should be noted and statements obtained; no admission of liability or promise of payment should be made to any injured party or for any property damage; All legal requests must be immediately advised to Australian Fencing Fed Ltd. and Arthur J. Gallagher. 2. Intimated/Actual Potentially Serious Claims Where a letter is received intimating a claim against the Insured, whether from a player, spectator, any third party, or from lawyers or proceedings are served, prompt action is vital. AVCC and Arthur J. Gallagher must be immediately advised, where possible, the same day as the letter or the service of the proceedings are received. 3. Documents to be sent to must include Completed Accident &/or Incident Report form. Copy of the letter of complaint. Writ/Court documents. Comments from the person who carried out any treatment at the scene and the club management comments. 6

9 Australian Veteran Cycling Council Inc. 4. Do not Admit liability nor offer any payment. Appoint solicitors without consent of Arthur J. Gallagher. Disclose policy terms unless legally required to do so. It is a requirement to advise of all incidents / circumstances, which might give rise to a claim against you. It is important that Insurers are notified of potential claims at the earliest opportunity so that a response can be agreed. Sports injury (personal accident) claims All claims should be lodged at least within 30 days of the date of injury. When a player is injured and wishes to submit a claim the following procedure needs to be followed: 1. Obtain a specialised sports injury claim form from Arthur J. Gallagher by calling 1800 SPORT 0 ( ) or ing sport.brisbane@ajg.com.au. 2. Arrange for your treating doctor to complete the Doctors Statement. 3. If claiming for loss of income, have your employer complete the Employer Statement. 4. Please forward your completed Sports Injury Claim Form to your Club Secretary who will on forward to the State Secretary for completion of declaration. 5. Send your fully completed claim form to the below: AVCC Sport Claims Arthur J. Gallagher GPO Box 1113 BRISBANE QLD 4001 Or sport.brisbane@ajg.com.au Or Fax: (07)

10 Australian Veteran Cycling Council Inc. Section 3 Frequently asked questions Q1 Emergency transport expenses What is the process for claiming for emergency transport expenses? 1. Incident occurs (club / organiser will have a log of the incident and is responsible for submitting incident report to Arthur J. Gallagher). 2. Transport provided. 3. Player is billed by transport provider. 4. Player claims via private/public insurance in first instance. Private/public insurance may not cover full cost of transport which can then be claimed against the Australian Fencing Federation personal accident policy. 5. Gap between private/public insurance can be claimed against AVCC personal accident policy. The Australian Fencing Federation personal accident cover is conditional on the event incident reports/logs being received from Organisers. 6. Claim for emergency transport occurs after account with transport provider has been settled. Players are encouraged to settle their account directly with the transport provider before seeking reimbursement through the AVCC personal accident policy. This will ensure that the player does not incur penalty charges. However, the AVCC insurer can pay the emergency transport provider directly, under the following circumstances. When private / public insurance exists: once player has claimed via private / public insurance, the benefit statement and emergency transport invoice can be lodged with the AVCC personal accident claim and the AVCC insurer will settle the gap directly to the transport provider. Q2 Medicare gap Does this insurance cover the GAP between the cost of medical treatment and the Medicare rebate e.g. physicians, surgeons, anaesthetists? No. Government legislation does not allow it. This policy cannot by law cover medical expenses that are covered by Medicare, including the gap between the expense and the Medicare rebate. However, if an injured AVCC member is covered by private health insurance, the personal accident policy will pay the balance above the private health insurance refund on expenses not claimable through the Medicare system, subject to the percentage reimbursement, the limit per injury and the excess applicable. Q3 Weekly benefits timeframe for payment If I am eligible, what is the ongoing timeframe for payments of the weekly benefit? Once the initial paperwork has been received and processed and the benefit has been deemed as available to your situation, we will request that you provide a doctors certificate outlining the dates that you are away from your employment and the condition from which you currently suffer. This certificate must not be longer than 4 weeks away from work and must be provided every 4 weeks. 8

11 Australian Veteran Cycling Council Inc. Section 4 Other matters Certificates of insurance A Certificate of Insurance can be obtained by contacting AVCC. Hold harmless agreements You will prejudice your rights of a claim if, without prior agreement from your insurer, you make any agreement that may prevent the insurer from recovering the loss from a third party. These hold harmless clauses are often found in leases, in maintenance or supply contracts (e.g. from burglar alarm or fire protection installers), building or repair contracts and sales agreements. If you are in doubt consult us. This notification requirement applies to all Property insurances and also to Public Liability insurance. It has a special connotation in Products Liability where you must not without the insurer s agreement, indemnify or hold a supplier harmless. Insuring the interest of other parties If you require the interest of any additional parties to be covered you MUST request this. Most policy conditions will exclude indemnity to other parties (e.g. mortgagees, lessors, principals etc.) unless their interest is properly noted on the policy. Utmost good faith Insurance contracts are subject to the doctrine of Utmost good faith and this is part of the law. Both parties must strictly adhere to utmost Good Faith and if you fail to do so, you may prejudice any claim. Notice regarding this manual The following points should be borne in mind at all times: 1. This manual provides a summary of cover only and does not replace, take precedence or form part of the insurance contracts arranged by us on your behalf. The insurance contracts, which are held by AVCC, provide details of the insurance terms, conditions and exclusions. 2. This manual is not intended to be a complete or exact guide to terms, conditions, warranties and exclusions of your insurance contracts. These can only be determined by studying the policy documents. This manual is intended to give you a broad working knowledge of the covers in place. 3. This manual is not to be construed as legal evidence of insurance. It is essential that you comply with all relevant laws, by-laws and regulations. You must take all due and reasonable precautions to prevent or mitigate losses, acting as though you were uninsured. Failure to do so may prejudice your rights and entitlements under your various insurance policies. Please do not hesitate to contact us should any assistance be required 9

12 Section 3 Appendices 10

13 Appendix 1.1 Arthur J. Gallagher Financial Services Guide 11

14 Appendix 1.1 Arthur J. Gallagher Financial Services Guide 12

15 Appendix 1.1 Arthur J. Gallagher Financial Services Guide 13

16 Appendix 1.1 Arthur J. Gallagher Financial Services Guide 14

17 Locally focused. Nationally resourced. Internationally represented. Direct to your AJG Sport branch 1800 SPORT 0 Arthur J. Gallagher & Co (Aus) Limited. ABN AFSL Prepared by: Terry Berryman Date 22 nd October